Li CC, Fu JP, Chang SC, et al. Plast Reconstr Surg. 2000;44(2):125-134. bottom: 20px; Three review authors undertook independent screening of the search results. 2016;20(3):256-260. Reduction mammoplasty or breast reduction surgery reduces the volume and weight of the female breasts by removing excess fat, glandular tissue and skin. Estrogens and estrogen like drugs,including: Drugsthat enhance estrogen formation, including: Drugs which inhibit testosterone synthesis, including, Drugs that inhibit testosterone action, including. He Q, Zheng L, Zhuang D, et al. Also, there was no correlation between PR expression and 2D: 4D. In a within-patient, randomized, patient- and assessor-blinded, controlled study, Anzarut et al (2007) evaluated the use of completely autologous platelet gel in 111 patients undergoing bilateral reduction mammoplasty to reduce post-operative wound drainage. They also analyzed if timing of reduction mammoplasty in relation to oncological treatment influenced the incidence of abnormal findings, and compared if patients with abnormal contralateral histopathology differed from the study population in terms of demographics. Can objective predictors for operative success be identified? It is not intuitively obvious, however, that breast weight would substantially contribute to back, neck and shoulder pain in women with normal or small breasts. Gynecomastia. OL OL OL LI { Gynecomastia resection plus high-definition liposculpture was successfully performed in 436 consecutive men (open inverted-omega incision resection, n = 132; liposuction, n = 304). Plast Reconstr Surg. However, it is unclear if there is any evidence to support this practice. These researchers calculated the risk ratio (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, with 95 % confidence intervals (CI). position: fixed; Laituri CA, Garey CL, Ostlie DJ, et al. 2001;76(5):503-510. The authors stated that operative subjects were told that their responses to the questionnaire were not to be used for insurance and thus the subjects had no motivation to exaggerate symptoms prior to surgery in questionnaire responses; however, it is not clear whether operative subjects would be willing to submit responses to a questionnaire from the doctor that differed substantially from the history that they provided to the doctor during their preoperative evaluation. Preoperative patient factors and comorbidities, as well as intraoperative variables, were assessed. The average age was 24.7 years (range of 18 to 47 years). Aesthet Surg J. 2008;121(4):1092-1100. Moreover, these researchers stated that further studies are needed within the common gynecomastia population managed by plastic surgeons to examine the clinical and economical utility of this intervention before a recommendation for its ubiquitous adoption in plastic surgery can be made to continue improving outcomes for high-risk gynecomastia patients. text-decoration: line-through; However, the BRAVO study is not of sufficient quality to reach reliable conclusions about the effectiveness of breast reduction surgery as a pain intervention. } An 18-question survey was created evaluating various aspects of BBR practice; UK and Irish plastic and reconstructive and breast surgeons were invited to participate by an e-mail containing a link to a web-based survey. Studies have suggested that 2.4% to 14% of breast reduction cases resulted in major complications and 2.4% . Breast reduction surgery is considered cosmetic for all indications not listed in section I, A. The authors concluded that the vacuum-assisted breast biopsy system could be used as a feasible and minimally invasive approach for the treatment of gynecomastia. Plast Reconstr Surg. 2015;75(4):383-387. For example, if the body surface area is 1.40 m2 , the estimated breast tissue to be removed should at least be 324 grams. Level of Evidence = IV. Measuring health state preferences in women with breast hypertrophy. The traditional method of breast reduction requires an open incision around the areola extending downward to the crease beneath the breast. Nelson et al (2014a) analyzed population data from the 2005-2010 American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. Iwuagwu OC, Stanley PW, Platt AJ, Drew PJ. Fat grafting to the breast can now be reported with CPT codes 15771 and 15772. 1999;103(6):1674-1681. In: Townsend CM, Beuchamp RD, Evers BM, eds. Patients were randomized to receive the gel applied to the left or right breast after hemostasis was achieved; the other breast received no treatment. Jansen DA, Murphy M, Kind GM, Sands K. Breast cancer in reduction mammoplasty: Case reports and a survey of plastic surgeons. Health insurance companies frequently have different criteria for whether breast reduction surgery is medically necessary. These preliminary findings need to be validated by well-designed studies. Karamanos et al (2015) identified their study as the largest sample on breast reduction in the literature, in which age and surgeon specialty did not correlate with negative results. Wound drainage after plastic and reconstructive surgery of the breast. Ann Plastic Surg. J Pediatr Surg. Often, you'll be eligible for Blue Cross Blue Shield breast reduction coverage if your surgeon plans to remove at least 500 grams of breast tissue per breast. See Appendix for Table 1. 1969;44(235):291-303. 01/04/2023 Links to various non-Aetna sites are provided for your convenience only. 2nd ed. Nor is it intuitively obvious that removal of smaller amounts of breast tissue would offer significant relief of back, shoulder or neck pain. Complications following reduction mammaplasty: A review of 3538 cases from the 2005-2010 NSQIP data sets. In a Cochrane review, Khan and colleagues (2015) stated that wound drains are often used after plastic and reconstructive surgery of the breast in order to reduce potential complications. Imahiyerobo TA, Pharmer LA, Swistel AJ, Talmor M. A comparative retrospective analysis of complications after oncoplastic breast reduction and breast reduction for benign macromastia: Are these procedures equally safe? Study subjects included 3538 patients with an average age of 43 years and body mass index of 31.6 kg/m(2) and most patients underwent outpatient surgery (80.5%) with an average operative time of 180 minutes.The incidence of overall surgical complications was 5.1% and the incidence of major surgical complications was 2.1%. Gonzalez FG, Walton RL, Shafer B, et al. 1991;27(3):232-237. PLoS One. Breast reduction surgery is considered reconstructive and medically necessary in certain circumstances . hr.separator { Effects of reduction mammaplasty on pulmonary function and symptoms of macromastia. 2014a;34(1):66-73. This Clinical Policy Bulletin may be updated and therefore is subject to change. Note: For breast surgeries pertaining to gender affirmation, refer to CP.MP.95 Gender Affirming Procedures. Schnur PL, Hoehn JG, Ilstrup DM, et al. Satisfactory chest contour was gained in all cases without any abnormality, skin redundancy, or recurrence during the follow-up of 6 to 48 months. Breast Concerns of Adolescents. cursor: pointer; In a survey of managed care policies regarding breast reduction surgery, Krieger and colleagues reported (2001)found that mostof the respondentsstated that they use weight of excised tissue as the main criterion for allowing the procedure, with anaverage cut-off value of 472 grams for a typicalwoman. Clinical outcomes were measured by operative subjects' responses to a questionnaire about symptoms and quality of life. Minor complications (3.2 %) included prolonged swelling, bruising, asymmetries, and residual gynecomastia. Grade IV: Marked breast enlargement with skin redundancy and feminization of the breast. 2021 Aug 11 [Online ahead of print]. Of these, 28.4 % were bilateral gynecomastia and 71.6 % were unilateral. The average interval between primary and secondary surgery was 14 years (range of 0 to 42 years). ul.ur li{ Ann Plast Surg. Pediatr Surg Int. The 2 vacuum-assisted breast biopsy systems (Mammotome and Encor) were used for the patients with gynecomastia. display: block; Emiroglu M, Salimoglu S, Karaali C, et al. In these cases, breast reduction for men may take 2 to 3 hours. Breast reduction surgery is considered cosmetic and not medically necessary for the following conditions: poor posture, breast asymmetry, pendulousness, problems with clothes fitting properly and nipple-areola distortion. background-color: #663399; Fischer et al (2014a) evaluated predictors of postoperative complications following reduction mammoplasty using the NSQIP) data sets. Plast Reconstr Surg. } Some individuals, however, have argued that reduction mammoplasty may be indicated in any woman who suffers from back and shoulder pain, regardless of how small her breasts are or how little tissue is to be removed (ASPS, 2002). The control group was not followed longitudinally or treated according to any protocol to ensure that they received optimal conservative management; conclusions about the lack of effectiveness of conservative management were based on their responses to a questionnaire about whether subjects tried any of 15 conservative interventions, and whether or not they thought these interventions provided relief of symptoms. The authors concluded that the incidences of malignant and high-risk lesions were doubled compared to patients without prior breast cancer. This conclusion is based primarily upon the Breast Reduction Assessment of Value and Outcomes (BRAVO) study, which is described in several articles (Kerrigan et al, 2001; Kerrigan et al, 2002; Collins et al, 2002). } The risks included infection, wound breakdown, scarring, and the need for re-operating. You may be able to buy a breast pump and supplies from one of our medical equipment suppliers at no charge or at a discounted rate. Gynaecomastia. border-radius: 4px; The following procedures are considered experimental and investigational because there is insufficient evidence of itseffectiveness or itseffectiveness has not been established: Aetna considers breast reduction, surgical mastectomy or liposuction for gynecomastia, either unilateral or bilateral, a cosmetic surgical procedure. In contrast, tobacco use and BMI were associated with worse breast reduction outcomes. 1995;34(2):113-116. Sood R, Mount DL, Coleman JJ 3rd, et al. It should be noted that this study reported a strong correlation between the amount of tissue removed and pain amelioration. From January 2006 to January 2010, a total of 20 men with gynecomastia were treated by an 8-G vacuum-assisted biopsy device. 2006;30(3):309-319. You must be at least 18 years old or show completed breast growth (no change in breast size over at least a year) to qualify for Aetna breast reduction coverage. 2012;69(5):510-515. Reduction mammoplasty performed solely for cosmetic indications is considered by insurers to be not medically necessary treatment of disease and subject to the standard cosmetic surgery plan exclusion. Devalia HL, Layer GT. Surg Laparosc Endosc Percutan Tech. Breast J. This Clinical Policy Bulletin addresses breast reduction surgery and gynecomastia surgery. In addition, reduction mammoplasty needs to be compared with other established methods of relieving back, neck and shoulder pain. 2003;111(2):688-694. Schnur PL, Schnur DP, Petty PM, et al. For the first update of this review, these investigators searched the Cochrane Wounds Group Specialised Register (searched March 4, 2015); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015, Issue 2); Ovid Medline (2012 to March 3, 2015); Ovid Medline (In-Process & Other Non-Indexed Citations March 3, 2015); Ovid Embase(2012 to March 3, 2015); and EBSCO CINAHL (2012 to March 4, 2015). To calculate body surface area (BSA) see:BMI and BSA (Mosteller) Calculator;orBSA (m2) = ([height (in) x weight (lb)]/3131)(denotes square root), BSA (m2) = ([height (cm) x weight (kg)]/3600)(denotes square root). Sugrue CM, McInerney N, Joyce CW, et al. Removing the adipose tissue in pseudogynecomastia usually has no long term effect as adipose tissue reaccumulates unless the individual loses weight. Gland Surg. Alternatively, you may qualify if your breast size causes significant symptoms, such as: Long-term neck, shoulder or neck pain. list-style-type: decimal; Follow-up ranged from 2 months to 3 years. Aetna considers molecular susceptibility testing for breast and/or epithelial ovarian cancer ("BRCA testing") medically necessary once per lifetime in any of the following categories of high-risk adults with breast or epithelial ovarian cancer (adapted from guidelines from the U.S. Preventive Services Task Force (for Mental health care professionals may be consulted to address psychological distress from gynecomastia. They reviewed their records on pectoral high-definition liposculpture between January of 2005 and October of 2019 in 4 surgical centers in Colombia. Aetna considers breast reconstructive surgery to correct breast asymmetry cosmetic except for the following conditions: Surgical correction of chest wall deformity causing functional deficit in Poland syndrome when criteria are met in CPB 0272 - Pectus Excavatum and Poland's Syndrome: Surgical Correction; or Plast Reconstr Surg. The authors concluded that treatment of gynecomastia by the Mammotome device was distinctive, practicable in manipulation, safe, and could achieve excellent cosmetic results. Of 291 subjects who were selected for inclusion in the study, only 179 completed follow-up. This will be computed based on your body area. These investigators retrospectively examined 83 patients with gynecomastia between January 2015 and December 2019. padding-bottom: 4px; Key takeaways: Health insurance does not cover cosmetic breast reduction, but it usually does cover breast reduction surgery that is considered medically necessary. Setala L, Papp A, Joukainen S, et al. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Surgical treatment of gynecomastia: Complications and outcomes. Apart from a significantly shorter LOS for those participants who did not have drains (MD 0.77; 95 % CI: 0.40 to 1.14), there was no statistically significant impact of the use of drains on outcomes. Little is known about the effect of surgical treatment on the psychological aspects of the disease. Plast Reconstr Surg. Please check your insurance policy to see whether breast reduction is a covered procedure. Copyright Aetna Inc. All rights reserved. An average of 320 specimens were excised from each side with mean blood loss of 34 ml. Vacuum-assisted minimally invasive mastectomy was performed successfully in all cases, with no residual glands or adipose tissue observed on US. Gynecomastia Treatment through Open Resection and Pectoral High-Definition Liposculpture. Fat grafting volume ranged from 50 to 300 cc in each pectoral muscle. The authors of the BRAVO study reached several conclusions about reduction mammoplasty, most notably that breast size or the amount of breast tissue removed does not have any relationship to the outcome of breast reduction surgery (Kerrigan et al, 2002; Collins et al, 2002). Kalliainen LK; ASPS Health Policy Committee. Of these 33 operative sides, 2 complications occurred, but satisfactory chest contour was attained in all subjects. Gynecomastia, its etiologies and its surgical management: A difference between the bilateral and unilateral cases? 2021;74(11):3128-3140. Initial breast reconstruction including augmentation with implants 15771-15772 (when specific to breast), 19325, 19340, 19342, C1789 Fat grafting (alone, or with implant based feminization) 15771, 15772 *Note: CPT 19318 (breast reduction) includes the work necessary to reposition and reshape the nipple . Bland KI, Copeland EM, eds. Lonie S, Sachs R, Shen A, et al. Arlington Heights, IL: ASPS; May 2011. Mayo Clin Proc. } Fagerlund A, Cormio L, Palangi L, et al. 2015;10(8):e0136094. The following factors were independently associated with any surgical complications: morbid obesity (odds ratio [OR], 2.1; P < .001), active smoking (OR, 1.7; P < .001), history of dyspnea (OR, 2.0; P < .001), and resident participation (OR, 1.8; P = .01) while factors associated with major complications included active smoking (OR, 2.7; P < .001), dyspnea (OR, 2.6; P < .001), resident participation (OR, 2.1; P < .001), and inpatient surgery (OR, 1.8; P = .01). Behmand RA, Tang DH, Smith DJ Jr. Outcomes in breast reduction surgery. } Tobacco use and body mass index as predictors of outcomes in patients undergoing breast reduction mammoplasty. Grooving where the bra straps sit on the shoulder. Hello! color: red!important; Nguyen JT, Wheatley MJ, Schnur PL, et al. For additional language assistance: Chemical exfoliation for acne (eg, acne paste, acid), Mastectomy, partial (e.g., lumpectomy, tylectomy, quadrantectomy, segmentectomy), Diagnostic mammography, including computer-aided detection (CAD) when performed, Photodynamic therapy by external application of light to destroy premalignant and/or malignant lesions of the skin and adjacent mucosa (eg, lip) by activation of photosensitive drug(s), each phototherapy exposure session, Photodynamic therapy by external application of light to destroy premalignant lesions of the skin and adjacent mucosa with application and illumination/activation of photosensitizing drug(s) provided by a physician or other qualified health care professional, per day, Basic life and/or disability examination that includes: Measurement of height, weight, and blood pressure; Completion of a medical history following a life insurance pro forma; Collection of blood sample and/or urinalysis complying with "chain of custody" protocols; and Completion of necessary documentation/certificates, Weight management classes, non-physician provider, per session, Mononeuropathies of upper limb [upper extremity paresthesia], Gangrene, not elsewhere classified [tissue necrosis], Non-pressure chronic ulcer of skin of other sites, Hypertrophy of breast [symptomatic-causing significant pain, paresthesias, or ulceration], Other specified disorders of breast [soft tissue infection]. Qu and colleagues (2020) examined the effectiveness of vacuum-assisted breast biopsy systems for the treatment of gynecomastia. The goal of medically necessary breast reduction surgery is to relieve symptoms of pain and disability. top: 0px; J Laparoendosc Adv Surg Tech A. Washington, DC: ACOG; 2011:121-122. Flancbaum L, Choban PS. The studies used to support the arguments for the medical necessity of breast reduction surgery are poorly controlled and therefore subject to a substantial risk of bias in the interpretation of results. Nelson JA, Fischer JP, Chung CU, et al Obesity and early complications following reduction mammaplasty: An analysis of 4545 patients from the 2005-2011 NSQIP datasets. J Plast Reconstr Aesthet Surg. Liposuction assisted gynecomastia surgery with minimal periareolar incision: A systematic review. Plastic Reconstr Surg. The mean incidence of gynecomastia was 70 % in the high-risk population examined representing prostate cancer patients on estrogen or anti-androgen therapy. outline: none; Fan L, Yang X, Zhang Y, Jiang J. Endoscopic subcutaneous mastectomy for the treatment of gynecomastia: A report of 65 cases. 2015;75(4):370-375. The author average amount of breast tissue removed for women in 5 kg weight bands, ranging from 45-49 kg to 90+ kg. Ann Chir Plast Esthet. Reduction mammaplasty: A review of managed care medical policy coverage criteria. Plast Reconstr Surg. Abnormal histopathology correlated with higher age (p = 0.0053), heavier specimen (p = 0.0491), and with no previous breast surgery (p < 0.001). Role of tamoxifen in idiopathic gynecomastia: A 10-year prospective cohort study. Patients with abnormal histopathology could not be pre-operatively identified based on demographics. The study consisted of 329 breast cancer patients, who underwent symmetrizing reduction mammoplasty between 1/2007 and 12/2011. 2013;71(5):471-475. Prasetyono TOH, Budhipramono AG, Andromeda I, et al. Araco A, Gravante G, Araco F, et al. Subjects were compared to age-matched norms from another study cohort. Reduction mammaplasty. Measurement of plasma gonadotrophins, human chorionic gonadotropin (hCG), testosterone, estradiol, and dehydroepiandosterone sulphate (DHEAS). Arch Dis Child. Note: Breast reduction surgery will be considered medically necessary for women meeting the symptomatic criteria specified above, regardless of BSA, with more than 1 kg of breast tissue to be removed per breast. Mannu GS, Sudul M, Bettencourt-Silva JH, et al. Nelson JA, Fischer JP, Wink JD, Kovach SJ 3rd. Henley et al (2007) reported that repeated topical exposure to lavender and tea tree oils may be linked to prepubertal gynecomastia (idiopathic gynecomastia). Kerrigan CL, Collins ED, Striplin D, et al. Breast and aesthetic surgery. Furthermore, no serious complications were observed in vacuum-assisted breast biopsy group. 1997;185(6):593-603. Harmonic scalpel versus electrocautery in breast reduction surgery: A randomized controlled trial. Plast Reconstr Surg. Marshall WA, Tanner JM. Krieger LM, Lesavoy MA. Jones SA, Bain JR. Review of data describing outcomes that are used to assess changes in quality of life after reduction mammaplasty. These investigators presented their experience with pectoral high-definition liposculpture combined with inverted-omega incision resection for gynecomastia. padding: 10px; Blomqvist L, Eriksson A, Brandberg Y. Breast reduction for symptomatic macromastia. The effectiveness of surgical and nonsurgical interventions in relieving the symptoms of macromastia. Doses examined ranged from 8 to 16 Gy, delivered between 1 and 11 fractions. } The 2 studies, which discussed laser-assisted liposuction technique, showed minor complication of seroma in 2 patients. Gynecomastia may be drug-induced. Aetna considers breast reduction surgery medically necessary for non-cosmetic indications for women aged 18 or older or for whom growth is complete (i.e., breastsize stable over one year) when any of the following criteria (A, B, or C) is met: Member has persistent symptoms in at leasttwoof the anatomical body areas below, directly attributed to macromastia and affecting daily activities for at least1 year: Member has severe breast hypertrophy, documented by high-quality color frontal-view and side-view photographs;and, Women50 years of age or older are required to have a mammogram that was negative for cancer performed within the twoyears prior to the date of the planned reduction mammoplasty;and. The median complication rate was 12.4 % with no major complications, such as neoplastic, pulmonary, or adverse cardiac outcomes. The authors recruited 67 consecutive female patients who underwent inferior pedicle reduction mammoplasty in order to determine the effects of resection weight, BMI, age, and smoking on complication rates following reduction mammoplasty.
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